“Oxy,” “Hillbilly-heroin” and “Killer” are a few of the street names for the prescription pain pill OxyContin, which about five years ago gained prominence among rural teens who discovered they could get a powerful morphinelike high by crushing and snorting the drug.

Since then, abuse of OxyContin has spread, killing hundreds and prompting an aggressive response by federal law-enforcement agencies, led by the Drug Enforcement Administration.

Only one local police department in the country has created its own task force to battle illegal use of the drug. Fairfax County has fought OxyContin since April last year, after a rash of robberies at pharmacies, police spokeswoman Lt. Amy Lubas said.

“Unlike with crack or other drugs, we were seeing entire families involved,” she said, explaining why the county keeps two full-time officers designated to working undercover along the underbelly of the OxyContin problem.

“Word on the street is that Fairfax County is ‘hot’ — you don’t want to do business there,” said one of the undercover officers, who met on the condition of anonymity with a reporter from The Washington Times.

The officer, “deputized” by the federal Bureau of Alcohol Tobacco, Firearms and Explosives so he can rove easily across county and state borders, has worked with federal and local police as far away as the hills of Tennessee to battle OxyContin.

He has been at the center of the fight in Virginia, the scope and intensity of which became clear in late June when federal prosecutors in Alexandria revealed elements of an ongoing probe of pharmacists, doctors and abusers.

Court papers indicate that 49 illegal dealers have been charged in Alexandria. Prosecutors said the bulk were arrested in Fairfax and Loudoun counties, where corrupt doctors rubber-stamped prescriptions for large quantities to people who sold pills on the black market for profit.

Last week alone in federal court in Alexandria, 10 of those arrested were sentenced, six pleaded guilty and one was on trial. The cases are the result of an integrated federal and local effort called Operation Cotton Candy.

Those sentenced are likely to serve between two and four years in prison, depending on how much OxyContin they have sold.

“This is an ongoing case with lots of activity,” said U.S. Attorney Paul J. McNulty.

“OxyContin has been a highly destructive controlled substance that has had a devastating impact in much of America, particularly in the western Virginia and Appalachian region,” he said.

“We have to be extremely aggressive in our prosecution. It’s a substance that is in great demand because it’s so addictive, and there’s a significant amount of money in it for traffickers, and that’s why we’ve had so many cases.”

Profit vs. risk

Dealing OxyContin can pose less of a legal risk than selling cocaine, crack or heroin, said Thomas P. Lesnak, an ATF agent in Southwest Virginia.

“One of the biggest problems is that when any law-enforcement officer pulls a car over and finds a prescription pill bottle in some guy’s pocket, that officer ends up giving it back to the guy if it has his name on it,” he said.

“Maybe that officer will write the guy a speeding ticket or whatever. If it had been a gram of cocaine valued at $100 in the guy’s pocket … he would be in jail, with felony charges.”

A former OxyContin dealer and abuser, who spoke with The Times on the condition of anonymity, said that selling one 90-pill prescription of 80-milligram OxyContin is more profitable than selling a kilogram of cocaine on the black market when the risk factor is weighed.

At the height of Virginia’s OxyContin boom, the former dealer says, he could obtain through corrupt “pain clinics” as many as 7,500 80-milligram OxyContin pills in six months.

“I could sell them at $25 to $40 apiece,” he says, adding that when law enforcement began cracking down, the price of pills jumped to “$60 to $80 apiece.”

During one six-month run, he said, he raked in close to $300,000. But the money didn’t last.

‘Path to hell’

The former dealer held a cigarette nervously as he told how OxyContin dissolved everything of meaning in his life.

“It put me on a path straight for hell with no exit ramps,” he said, lighting the smoke and pulling on it hard.

He quit abusing and selling OxyContin more than a year ago and since has worked as an informant for police.

“That pill was made by the devil himself,” he said. “It ruins your family and your relationships, your children’s lives, your closest family to you, your job. One day you try to quit and two or three days later, you’re puking your brains out.”

It started with a doctor prescribing him the pill for a severe neck ache, advising that it was the best medicine to ease the pain. While from the start he felt dependent on OxyContin, he also felt normal. The pain was gone, but the dosage increased with time, until the doctor gave him a note for a pain clinic, which could prescribe more pills at a faster rate.

“That’s when everything went to hell,” he said. With no insurance to pay for the pills, “you turn to being a pusher.”

He fell in with a network of abusers using the same pain clinic and facing the same bills. He sold chunks of his prescriptions, the size and the frequency of which, he said, simply went unmonitored.

“You could go out and get pills over and over again,” he said. “If you get a bank of cash going, you can start buying from the pain clinic for others under their names.”

Most users simply popped the pills into their mouths and swallowed. Then came more advanced tactics: rubbing the pills under warm water to remove the time-release coating, crushing the pills to powder to be snorted, mixing the powder with water and cooking it to be injected.

“I was looking in the mirror and no one was looking back,” the young man said of his life for three years without a job, at times swallowing so many pills that he would crash for days at a time. “I would crash and wake up three to four days later. Literally three or four days are gone.”

Serious drug

The pharmaceutical firm Purdue Pharma introduced OxyContin in 1995 to treat chronic, moderate to severe pain for extended periods of time. The DEA says the number of prescriptions rose to nearly 5.8 million in 2000.

The drug’s appeals are its large amounts of active ingredient oxycodone and the ease with which abusers can negate its controlled-release formulation. By simply crushing a pill, abusers can swallow or snort it for a powerful morphinelike high.

While authorities say the number of abusers may have steadied, OxyContin has established itself as a serious drug with a bedrock of abusers in certain locales. It has gone from a rural party pill to a serious drug like crack or heroin with ties to burglary, armed robbery and homicide.

The ATF opened an OxyContin task force in Southwest Virginia after assessing spiking crime rates there at the end of the 1990s.

“Every year from 1996 to 1999, the crime rate doubled directly because of the influx of OxyContin,” Mr. Lesnak said.

The crime most commonly connected to OxyContin abuse is gunrunning, or selling stolen guns at open-air flea markets.

“When we get to the point where people are using guns to facilitate their trafficking, that’s where we get involved,” said Jeff Rhoem, ATF special agent in charge of the Washington field division.

In December 2001, the DEA targeted OxyContin amid sharp increases in its availability as a prescription drug diverted for illegal use. At the time, Terrance W. Woodworth, the agency’s deputy director for diversion, said the DEA would target unethical doctors, forged and fraudulent prescriptions, pharmacy theft and doctor shopping.

The agency maintains it has made 489 OxyContin-related arrests since 2000, with 207 in 2001.

Investigations typically are coordinated through U.S. attorney’s offices to include local and federal authorities, said Donetta Spears, diversion program manager for the DEA’s Washington division, which oversees investigations in the District, Maryland, Virginia and West Virginia.

“In Virginia, we have local police officers working in [some of] our DEA offices,” she said. “If it wasn’t for them, we would have a hard time.”

Still, some in the law-enforcement community say the DEA is too concerned with fighting the OxyContin problem from the top down rather than hitting it on the streets, where it has done the most damage.

“They’re not out there making buys and busts and running sting operations. … Working with pharmacists is important, but it doesn’t attack the crime rate,” said one authority in Virginia, speaking on condition of being identified as a frustrated law-enforcement official.

Mrs. Spears rejects the criticism, saying the DEA works “hand in hand” with other authorities, the ATF included, to share information.

“The doctors are the distributors,” she said. “We are going after the distributors and the suppliers. The only way we can do that is to also work on the street level and see who is buying and putting it on the street.”

Coal miner theory

Several law-enforcement authorities interviewed by The Times suggested that OxyContin’s illegal use originated via the coal mines of Kentucky and West Virginia, where self-medicating had long been a way of life for miners spending hours a day crouched in mine shafts.

Treatment admissions in Kentucky for abuse of OxyContin and a less-addictive painkiller, Percocet, increased 163 percent from fiscal 1998 through fiscal 2000, the Justice Department’s National Drug Intelligence Center reported.

In years past, coal mine camp doctors dolled out painkillers to keep miners working. The practice often led to abuse and addiction. Law-enforcement authorities noted that during the late 1990s in heavy coal mining areas of Southwest Virginia, miners were afforded liberal government disability packages.

Retired miners with black lung, bad backs and bad knees received OxyContin through those packages. Authorities say the drug’s illegal use spread when curious teens sneaked pills from their parents’ prescription bottles. This, as the coal miner theory goes, is how OxyContin traveled the course from over-the-counter painkiller to party drug abused by rural teens.

By 2001, the drug was being taken in lethal doses and destroying communities nationwide, although mainly in the East from Maine to Maryland, Virginia, West Virginia, Tennessee, Florida and Kentucky.

In some areas, it grew to claim more victims than cocaine and heroin. Published reports in Broward County, Fla., for example, showed that 105 persons died from OxyContin overdoses from January 2001 to July 2002. In the same period, 80 died from cocaine overdoses and 65 from heroin.